T2 Fluid-Attenuated Inversion Recovery Imaging of Uveal Melanomas and Other Ocular Pathology

Abstract

Background/aims: This study describes patterns of intraocular lesions on T2 fluid-attenuated inversion recovery (FLAIR) imaging, exploring a prospective role of FLAIR imaging sequence in diagnosis and treatment.

Methods: A retrospective study of orbital magnetic resonance imaging (MRI) studies from the years 2000 to 2015 was performed. MRI sequences included: pre-contrast T1-weighted, T2-weighted, T2 FLAIR, and postcontrast T1 and T2 imaging gadolinium, which were evaluated by a neuroradiologist. Two cases of melanoma were correlated to their pathology.

Results: Twenty-four patients with intraocular pathology were evaluated. All lesions, regardless of pigmentation, revealed previously described melanotic patterns on T1- and T2-weighted images; 80% of 10 melanomas localized were hyperintense on T2 FLAIR, which better delineated lesion margins. All of the four inflammatory pathologies on T2 FLAIR were hyperintense, as were 80% of the amelanotic neoplasms. Pathology of two large uveal melanomas paralleled the findings seen on T2 FLAIR.

Conclusions: T2 FLAIR appears beneficial in the demarcation of pigmented ocular lesions and may aid in determining protein content or previous treatment. Data also promote previous assertions that blood flow impacts intensity of lesions on T2 FLAIR. Further research is warranted.

Keywords: Choroidal hemangioma; Magnetic resonance imaging; Melanoma; Posttreatment changes; T2 fluid-attenuated inversion recovery; Uveal melanoma.

Fig. 1

Schematic showing the breakdown of MRI scans analyzed.

Fig. 2

Uveal melanoma. Example of T1-weighted image (a) compared to T2 FLAIR image (b), with more conspicuous hyperintensity on the latter image.

Fig. 3

Choroidal hemangiomas. a-c Subject from initial group. T1-weighted image (a) and T2 FLAIR image (b). T2-weighted image showing vessel penetration of sclera (c). d, e Additional case. T1-weighted image (d) and T2 FLAIR image (e).

Fig. 4

Choroidal effusion. T1-weighted image (a) and T2 FLAIR image (b).

Fig. 5

Asymmetrical hyperintensities found on T2 FLAIR images from five different patients (a-e).

Fig. 6

Uveal melanoma seen on T2 FLAIR image (a), with corresponding gross (c) and histological (d) findings. Another uveal melanoma with T2 FLAIR, gross, and histology (b, e, and f, respectively) shown for comparison.

Fig. 7

Posttreatment changes. T2 FLAIR images of a melanoma prior to (a) and 11 months after radiation therapy (b). A second case of melanoma on T2 FLAIR prior to (c) and 9 months after radiation therapy (d).